Diaper Rash: Are You Ready to Diagnose and Treat?

Everybody knows that babies get diaper rash, but diaper rash can be more than one condition. Sometimes it is not even caused by diapers. Some conditions that look like a diaper rash are actually infections or a skin disease. This review can help you diagnose the cause of your baby’s rash, know when to treat it yourself, and know when to call the doctor.

Not all babies get diaper rash, there is about a 50 percent chance you won’t have to deal with it. A recent study published in the medical journal BMC Dermatology, found that only about 40 precent of baby bottom rashes were caused by diapers. Other rashes were caused by infections that were made worse by wearing a diaper, and about one-fourth of rashes were caused by a skin disease unrelated to wearing a diaper. So, how can you know the difference?

Irritant Diaper Dermatitis (IDD)

IDD is your basic diaper rash caused by wearing a dirty diaper for too long. The irritation comes from stool and urine that is contact with your baby’s skin. Your baby may be at higher risk for IDD if he or she has diarrhea or during teething. You can diagnose IDD by it’s color and location. The rash is pink to bright red, appears in patches, and occurs mostly on the baby’s bottom. Because skin creases in the groin area do not come into contact with stool or urine, this rash spares the skin creases.

You can usually treat IDD on your own and expect it to go away in a few days. The key to treatment is changing diapers more frequently and cleaning with a warm water rinse or dunk. Avoid wipes that contain alcohol, fragrance, or soap. Use a mild cleanser or just warm water and rinse without scrubbing. Pat dry and then let your baby go without a diaper for a while.

You can use petrolatum jelly or zinc oxide cream to coat and protect the skin. The American Academy of Pediatrics (AAP) recommends putting cream on thickly, like icing on a cupcake. The old days of using baby powder or any powder are over. AAP says avoid all powders because they could be dangerous for your baby’s lungs. Don’t put diapers on too tightly, especially at night. A loose diaper lets some air in and decreases rubbing and irritation. Although studies have not found that cloth diapers or disposable diapers make a big difference, disposable diapers are more absorbent and may be the better choice.

Yeast Infection Diaper Rash 

Yeast is a type of fungus that likes to grow in warm, most areas. Unlike IDD, it usually starts in groin folds. The rash looks redder and shinier than IDD, and there may also be little bumps or pimples. There may be little “satellite rashes” scattered on other areas near the skin creases. Your baby will be at higher risk for this rash if she or he needs a course of antibiotics. In addition to the usual diaper rash treatment, you should call your doctor for this rash. Your doctor may want to see the rash and prescribe an anti-fungal medication.

Bacterial Infection Diaper Rash

Bacterial infection, called impetigo can occur like a fungal infection in warm and moist skin creases. A staph infection causes yellow crusting pimples, that may weep fluid. A strep infection causes deep redness around the anal area, called perianal strep. Don’t try to treat this rash on your own with an over-the-counter antibacterial ointment. It could make the infection worse. If you suspect this cause, call the doctor right away.

Allergic Diaper Rash 

Some babies may have an allergic reaction to their diaper, wipes, creams, or soaps. Some may even be allergic to the elastic in the diaper. This rash looks like an IDD rash, but it does not respond to the usual treatments. Sometimes you can diagnose it by seeing if the rash goes away with a different diaper, cream, or soap. If you suspect an allergy, let the doctor know. Your baby may need to use a cream with a steroid.

Rashes Not Related to Diapers

There are several skin diseases that cause rashes in diaper areas. The most common is a skin condition called seborrheic dermatitis, sometimes referred to as baby psoriasis. It causes a pink rash that occurs in skin folds under a diaper and in other areas like the neck or scalp. There are some other rare inherited skin diseases that can be mistaken for a diaper rash. The key to these rashes is that they usually occur in other areas as well as the diaper area. Call the doctor if your baby has diaper rash with other rash areas.

When to Call the Doctor 

Call your baby’s doctor if you suspect a rash that is not the typical IDD diaper rash. If in doubt, AAP says call the doctor if:

  • The rash lasts more than two or three days and is not getting better or is getting worse.
  • The rash has areas of peeling or blistering skin, pus filled pimples, or any oozing or crusting sores.
  • Your baby has a rash after taking antibiotics.
  • Your baby has a rash with a fever.
Christopher Iliades
Dr. Chris Iliades is a medical doctor with 20 years of experience in clinical medicine and clinical research. Chris has been a full time medical writer and journalist since 2004. His byline appears in over 1,000 articles online including EverydayHealth, The Clinical Advisor, and Healthgrades. He has also written for print media including Cruising World Magazine, MD News, and The Johns Hopkins Children's Center Magazine. Chris lives with his wife and close to his three children and four grandchildren in the Boston area.

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